Armen Todd A, Vandse Rashmi, Crestanello Juan A, Raman Subha V, Bickle Katherine M, Nathan Nadia S
Department of Anesthesiology, Ohio State University Medical Center, N-416 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, USA.
Eur J Echocardiogr. 2009 Jan;10(1):74-81. doi: 10.1093/ejechocard/jen165. Epub 2008 May 13.
Left ventricular remodelling leads to functional mitral regurgitation resulting from annular dilatation, leaflet tethering, tenting, and decreased leaflet coaptation. Mitral valve annuloplasty restores valve competency, improving the patient's functional status and ventricular function. This study was designed to evaluate the mechanisms underlying mitral valve competency after the implantation of a Geoform annuloplasty ring using three-dimensional (3D) echocardiography.
Seven patients (mean age of 65 years) with ischaemic mitral regurgitation underwent mitral valve annuloplasty with the Geoform ring and coronary artery bypass surgery. Pre- and post-operative 3D echocardiograms were performed. Following mitral annuloplasty, mitral regurgitation decreased from 3.4+/-0.2 to 0.9+/-0.3 (P-value<0.0001), mitral valve tenting volume from 13+/-1.7 to 3.2+/-0.3 mL (P-value<0.001), annulus area from 12.6+/-1.0 to 3.3+/-0.2 cm2 (P-value<0.0001), valve circumference from 13+/-0.5 to 7.3+/-0.3 cm (P-value<0.0001), septolateral distance from 2.1+/-0.1 to 1.4+/-0.06 cm (P-value<0.01) and intercommissural distance from 3.4+/-0.1 to 2.7+/-0.03 cm (P-value<0.03). There was significant decrease in the septolateral distance at the level of A2-P2 with respect to other regions. These geometric changes were associated with the improvement in the NYHA class from 3.1+/-0.3 to 1.3+/-0.3 (P-value<0.002).
The mitral valve annuloplasty with the Geoform ring restores leaflet coaptation and eliminates mitral regurgitation by effectively modifying the mitral annular geometry.
左心室重塑导致功能性二尖瓣反流，其原因包括瓣环扩张、瓣叶牵拉、帐篷样改变以及瓣叶对合减少。二尖瓣瓣环成形术可恢复瓣膜功能，改善患者的功能状态和心室功能。本研究旨在使用三维（3D）超声心动图评估植入Geoform瓣环成形环后二尖瓣功能的潜在机制。
7例（平均年龄65岁）缺血性二尖瓣反流患者接受了Geoform环二尖瓣瓣环成形术和冠状动脉搭桥手术。术前行3D超声心动图检查，术后复查。二尖瓣瓣环成形术后，二尖瓣反流从3.4±0.2降至0.9±0.3（P值<0.0001），二尖瓣帐篷样容积从13±1.7降至3.2±0.3 mL（P值<0.001），瓣环面积从12.6±1.0降至3.3±0.2 cm²（P值<0.0001），瓣膜周长从13±0.5降至7.3±0.3 cm（P值<0.0001），间隔-外侧距离从2.1±0.1降至1.4±0.06 cm（P值<0.01），瓣间距离从3.4±0.1降至2.7±0.03 cm（P值<0.03）。相对于其他区域，A2-P2水平的间隔-外侧距离有显著降低。这些几何变化与纽约心脏协会（NYHA）心功能分级从3.1±0.3改善至1.3±0.3相关（P值<0.002）。
使用Geoform环进行二尖瓣瓣环成形术可通过有效改变二尖瓣环几何形状恢复瓣叶对合并消除二尖瓣反流。
